Smartbone® on demand - clinical cases

The Serbian Soldier Case

A complex maxillo-facial reconstructive case performed with SmartBone On Demand.

We received a case of a Serbian soldier who reported a deep wound, due to the explosion of a grenade, during former-Yugoslavia’s war. His left cheekbone was completely lost, together with the pavement of the left eye.

Battlefield military surgeons provided him, at that time, their best efforts, reconstructing the missing bone segments with alloplastic cartilages held by metal wires. The case was complex as far as it involved different small bones below his left eye: a critical area that deeply influences face expressions and ocular symmetry.

When trauma causes large defects in the maxillofacial compartment, bone tissue cannot heal spontaneously and a maxillofacial surgery intervention becomes necessary. An advanced technique seemed the only possible solution for such a difficult case and it implied custom-made bone grafts generation.

SmartBone, with its proven high performances (similarity to natural bone, high biocompatibility, mechanical strength also at small thicknesses, ability to be shaped without powder formation or unpredicted fractures) allowed the realization of custom-made grafts which perfectly fit the bone defect.

Patient's initial condition
Patient's initial condition
Project
Project
Project
Project
Project
Project
Surgery
Check-up after surgery
Follow up 9 months / 2 years
Histological analysis 2 years
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Here is the procedure, which led to the implantation of custom-made bone grafts on this patient:

1 – Acquisition of patient’s CT scan and creation of a 3D real model (by 3DiEmme) of its skull, allowing the surgeon to physically study the case and wax model the grafts (with the assistance of SurgiPlanner).

02 - Digital Planning2 – scanning of wax models and importing into virtual environment for optimisation (in this case into 4 pieces) and final control on 3D skull render (obtained from patient’s CT scan).

3 – generation of numerical graphical files (.stl) of each graft, to be used for machining of real bone grafts

4 – Milling machine procedure: the needed grafts were obtained from raw material blocks and then underwent IBI proprietary reinforcement treatment, thus becoming SmartBone®!!

5 – final production quality inspections were performed before packaging and sterilization (EtO). Very last quality controls were then performed before shipment to the surgeon.

6 – Maxillofacial surgery intervention: easy positioning of the bone grafts thanks to a perfect fitting in the patient’s skull and correct fixation with few screws and a plate. Thanks to very high mechanical performances of SmartBone, only 5 small screws were used to fix all the grafts and the plate (which was fixed with one of the fixations screws of the graft!).

For the first time a successful maxillofacial surgery technique meets such an advanced material with adequate requirements:

– in the preoperative phase, capability to withstand any fine shaping;

– during surgery, mechanical resistance to screw fixation and harsh maneuvers;

– in the postoperative phase, graft solidity and good osteo-integration.

 

Date:March/2012
Location:Istituto Ortopedico “Galeazzi”, Milan, Italy
Surgeon:Dr. Francesco Grecchi
Product:Smartbone on Demand
Surgery:Left cheekbone and orbital pavement reconstruction (traumatic injury)
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